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Patient Out-of-Pocket Costs — Getting Paid In a Timely Manner

Rob MorrisThis article is written by Rob Morris, Vice President, Marketing and New Business Development at CareCredit, a part of GE Capital.

With increasing deductibles and co-pays, it’s even more critical for ambulatory surgery centers to inform patients of their financial responsibility as early as possible to allow them to secure funds needed to cover the facility fee. Industry experts often warn about the difficulties ASCs can face attempting to collect co-pays and deductibles after the procedure and patient discharge has been completed. Here are two ways you can set patient expectations and help ensure that you receive payment in a timely manner.

1. Educate patients in advance of the procedure

It’s important to make sure patients fully understand their financial obligation prior to coming in for their procedure. Here's how you can communicate and reinforce payment expectations.

•    On the phone. The routine phone call made to patients a few days in advance of their scheduled procedure is typically a time used to discuss the particulars of their procedure and responsibilities including; insurance verification, patient history, the time and location of the procedure, what the patient can eat or drink prior to surgery and what they should bring to the ASC. After these responsibilities have been discussed, time should be taken to review the patient’s financial obligation including what they owe for the facility fee and what arrangements can be made for payment.

•    In the mail. To remind patients of their financial obligation, a letter should be sent indicating the facility fee in advance of the procedure date. The letter should inform patients that if they are not able to pay the amount in full on the day of surgery they need to contact the facility immediately to discuss their payment options.

On the day of the procedure patients may be concerned about their ability to use traditional means of payment (cash, check or credit card) to cover the facility fee. That's why it's important to offer payment alternatives like a third-party patient financing program. A third-party program lets you offer special financing options that address cost concerns in advance of the procedure.

Some facilities may try and help patients manage fees by billing them
in-house. This can be a costly way to assist patients and result in reduced cash flow and higher accounts receivable for the center. Research shows that once an A/R account goes over 90 to 120 days, the chances of being paid are significantly lowered.

While every attempt should be made to get paid, even if it means handing the patient over to a collection agency, when efforts fail, uncollected fees become a bad debt write-off that can further impact a center financially. That's why many practices have found that offering a third-party financing program is a better way to help patients manage deductibles and out-of-pocket costs not covered by insurance.

2. Introducing and sharing payment options

Ensuring that your staff effectively communicates the payment options available at your center will minimize confusion and help patients move forward with care. It all starts with a comprehensive financial policy.  

•    Creating a comprehensive financial policy. Studies show that the average American has only $300 available credit on their consumer cards, and find it difficult to write a check for more than $500 out of their monthly budget. So out-of-pocket costs beyond $500 can often be a financial strain on patients. To help more patients address cost concerns centers should have in place a comprehensive and clear financial policy.

A comprehensive financial policy ensures that patients know what forms of payment are accepted by your center and when payment is expected. The policy should be written and specific, leaving little room for interpretation or misunderstanding. For example, it should clearly outline the patient’s responsibility regarding insurance benefits, fees not covered by insurance, etc. The policy should also include a variety of payment options including patient financing.

•    Introducing your policy to patients. Once you have added a patient financing program to your financial policy review with your team so that everyone understands the terms and options. It’s often helpful if team members practice scripts and do some role-playing to be comfortable explaining payment obligations and options to patients.

Here’s an example of how you can easily incorporate payment options into a discussion about your financial policy:

"Mr. Jones, the cost for the procedure we've discussed is going to be $2,350. We anticipate your insurance benefits will cover $1,500, leaving you with an out-of-pocket expense of $850. We have several convenient payment options to help you get the care you need. Let me go over them with you…"

Be sure display a copy of your financial policy in the reception area so that patients can review it when they walk into the practice. You should also include a copy of your policy as part of every new patient's paperwork. Have patients sign a copy of the financial policy and place it in their file as a record of their acknowledgement and understanding of your center’s policy.    

Although many patients may be facing higher insurance deductibles and self-pay portions, by clearly setting expectations and communicating your centers financial policy you can minimize confusion and help to ensure that you receive your facility fees when due.  

More Articles on Surgery Centers:
5 Recent Surgery Center Leadership Updates

5 Reasons to Bring the Surgery Center Pre-Admission Process Online

5 Ways Single-Specialty ASCs Can Flourish for Physician Owners


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